Classification: Internal Use
JOB SAFETY ANALYSIS – WORKSHEET
IBN SINA/SABIC
JOB SAFETY ANALYSIS
JOB LOCATION (Plant): IBN-SINA
No BASIC STEP
1.1 Injury / damage as a
1 Obtain Permit to work and
associate Certificate.
1.2 Unauthorized personal
2.1 Risk of back injury.
2 Manual material handling
by using Rope and Trolley.
JOB DESCRIPTION: ELECTRICAL WORKS. DATE:11/06/2022 JSA Number:03
IBNSINA/SCC_2022-06
Mobilization of tools & material, conduit piping REV #01
includes hot work: Drilling, chipping, cutting,  NEW REVISED
threading, bending/ cable pulling/installation of
light pole and other electrical equipment, WP No:
Common activity: Tie ins, testing &
commissioning
AREA: New chemical storage
Risk Level
Significant
(S)/Moderat
POTENTIAL HAZARDS MITIGATION PLAN RESPONSIBILITY e (M)/
Low (L)
1.1.1Obtain correct permit and Certificate for the
job.
result of incorrect 1.1.2Authorized permit receiver apply the Receiver/
information. work permit according to activity. Supervisor L
1.1.3All personals must have conducted / Safety officer.
safety induction.
1.1.4 Daily conduct toolbox talk and
task brief to all crewmembers
before starting the job.
1.2.1The permit issuer and receiver prior to the
issuance and acceptance of the PTW shall
conduct work area inspection.
1.2.2PTW shall be available and Visible all time at
job site.
1.2.3 Conduct Take two as per SHEM 08.10 work
permit procedure and take all crew members
sign on work permit.
2.1.1Physically fit persons to be assigned
for any manual work.
2.1.2Training to be given regarding manual
handling.
2.1.3Where possible, used mechanical Receiver/ L
means to transfer loads and reduced Supervisor
distance if possible. / Safety officer.
2.2.1Worker use standard Basic PPE’s, and
Classification: Internal Use
3 Heavy Equipment
Operations for erection of
light pole & Material
Shifting by using Forklift,
Trailer and crane.
4 Hot works Activities conduit
piping (cutting/grinding/ Drilling/
chipping/ threading/bending)
2.2 Contact with sharp special PPE anti cut type glove must be
edges. used.
2.2.2Exposed sharp edges shall be
protected and covered.
3.1.1 Ensure that all heavy equipment
3.1 Injury or operators are qualified and have valid
damage to Saudi driving licenses and Third party
property resulted Certified (TUV) holder. As per SHEM
from unqualified 05.00 procedure.
operator.
3.2.1 Operator shall conduct a Daily periodic
inspection. Operator shall check at the Receiver/Supervisor
start at the work shift the oil, fuel, / Safety officer. L
water, hydraulic levels and gauges of his
3.2 Accident / incident equipment and report any unsafe
related to mechanical condition of his equipment.
equipment failure. 3.2.2 Ensure that all heavy equipment shall
be maintained in operable condition,
including seat belts.
3.2.3 Follow the Flag man signals when
invisibility for any obstruction.
3.2.4 Resting inside operator cabin & inside
the plant is prohibited.
4.1.1 Welders must wear welder’s apron when
engaged in welding and fire retardant
gloves or leather gloves.
4.1.2 Maintain good cable management and wire
splicing is not allowed.
4.1 Toxic fumes, 4.1.3 Earthling on welding machine and the steel to
Electrocution and be welded must be properly connected.
body burns. 4.1.4 Helpers extending or handling rods to the
welder must not set his eyes directly to
the light emitted during welding.
4.1.5 Welders should use proper safety lens when
welding.
4.1.6 Job supervisor will ensure that ample water
supply is readily available for the Receiver/ L
Supervisor
workers. / Safety officer.
4.1.7 Workers are advised to drink plenty of
water. During extreme heat
condition, rest schedule should be
implemented and provided.
4.2 Physical injury 4.2.1 Do not use defective electrical tools.
4.2.2 Always ask the supervisor the proper work
procedure.
Classification: Internal Use
5 Weather Condition.
4.2.3 Do not attempt to remove machine guards.
4.2.4 Use appropriate PPE(face shield, ear
protection, dust mask).
4.2.5 Heavy tools or material should not be
lifted manual.
4.3.1 Tools must be inspected before each
used and must bear the color coding of
4.3 Power tools the month.
failure that 4.3.2 Power cables must be maintained in
could lead to such a way that it is not blocking the
electrocution, access and fire point.
Fire hazard 4.3.3 Properly arranged to avoid slip and
tripping hazard.
4.3.4 Remove all flammable and
combustible materials within 10
meters radius where the activity is
being done.
4.3.5 Provide certified fire watchman.
4.3.6 Follow hot works requirements by
providing sufficient fire blank etc. fire
extinguisher.
4.3.7 Rated rpm of the grinding disk that is
going to be used for grinding must
have a higher rpm than the grinding
machine
5.1.1 Plan to work in the low humidity weather.
5.1.2 Consider physical condition of the
workers assigning for the job.
5.1.3Provide Rest shelter with fans. Take
frequent break and personal rotation.
5.1.4Drink plenty of cool water.
5.1.5Follow the IBN SINA SHEM 12 Industrial
5.1 Heat stress/ Heat hygiene procedure, heat stress
stroke. (Fatigue, category system: Receiver/Supervisor
weakness, dizziness, Category (0): Continues work. L
/ Safety officer.
faintness, nausea and Category (1): 45 Min work 15 Min
headache.) Break Per hour.
Category (2) : 30 Min work 30 Min
Break Per hour.
Category (3) : 15 Min work 45 Min
Break Per hour.
Category (4) : No Work Outside except
the emergency adhering to the following
procedure.
5.1.6 Supervisor should consider personal rotation.
Classification: Internal Use
Cable pulling,
6 6.1.2 Always maintain the proper body posture
7 Installation of Electrical
equipment
5.1.7 Water/ Isotonic Drink/ Juice should
always be available at work place.
5.1.8Shade should be provide with a
source of air movement.
5.2 Cold Stress 5.2.1 Have hot drinks.
5.2.2 Rest in the warm place.
5.2.3. Make your body Warmer.
6.1 Back & hand injury. 6.1.1 Obtain the required Work Permit in
accordance with SHEM-08.10 (Work Permit)
during the cable pulling.
6.1.3 Always keep your back erect and avoid the
prolonged static posture and observe kinetic
handling. Receiver/
6.1.4 Avoid excessive power while pulling the Supervisor
cable. / Safety officer. L
6.1.5 Do not use defective or damage PPE’s.
6.1.6 Ensure the area is clear from obstruction.
6.1.7 Coordination to the area owner and follow
the approved area.
6.1.8 Do not block the walkway
6.1.9 Experienced technician must carry out this
job under proper Supervision with valid
work permit.
6.2 Ergonomics hazards
6.2.1 Physically fit persons to be assigned for the
manual lifting.
6.2.2Training to be given regarding manually
material adding.
6.2.3Where possible, used mechanical means to
transfer loads and reduced distance if
possible.
6.3 Tripping hazard 6.3.1 Barricade the area with warning sign.
Fall hazard 6.3.2 Proper cable management
should be observed to avoid
any kind of tripping hazard
6.3.3 Use cable lubricants to reduce the tightness
while pulling and to avoid cable insulation
damage
7.3.1.1. Use proper PPE(anti cut type of gloves).
7.1 Hand injury Do not use defective PPE’s.
7.3.1.2. Do not use defective electrical tools.
7.3.1.3. Always ask the supervisor/ engineer for
the proper work procedure before start
any job.
Classification: Internal Use

7.3.1.4. Only qualified person can carry out the

work. Receiver/ L
7.3.2.1. Experienced technician must carry out Supervisor
this job under proper supervision with / Safety officer.
valid work permit.
7.2 Falling 7.2.1 Barricade the area with warning sign.
7.2.2 All material should be secured on the
elevated area.
7.2.3 100%tie off.
7.2.4 Material should not be stored on scaffolding
platform.
7.2.5 Drop zone must be provided while working
on the elevated area.
7.2.6 3 point contact and ladder should be hold by
a person.
7.3 Exposure to Flying 7.3.1 Use dust mask.
dust particles. 7.3.2 Use face shield to avoid the contact of
flying concrete particle with face.
7.3.3 Drilling machine must be inspected from IBN
SINA maintenance departments.
7.3.4 Use respiratory protection.
7.4 Tripping hazard. 7.4.1 Proper cable management.
7.4.2 All material should be stored in a proper
manner and barricaded.
7.4.3 Maintained good housekeeping.
7.5 Exposure to 7.5.1 Make sure gas test has been done.
excessive noise. 7.5.2 Adequate fire watch man provided all time.
7.5.3 Always adopt proper ear protection.

8.1.1 Obtain the required Work Permit in

8. TIE INS 8.1 Electric shock. accordance with SHEM-08.10 (Work Permit)
(Electrical,) 8.1.2 Obtain LOTO certificate.
8.1.3 Use insulated tools.
8.1.4 Competitive and skilled technician will
carried out the job
8.1.5 Appropriate approval shall be obtain prior to Receiver/
the job L
8.1.6 Grounding should be provided Supervisor
8.1.7 Check thrice power is completely isolated / Safety officer.
before commencing the job.

8.2 Physical injury. 8.2.1 Appropriate basic PPE(& working gloves)

shall be used in accordance with SHEM-
08.08
8.2.2 Physically fit persons to be assigned for the
manual lifting.
Classification: Internal Use

8.3 Stuck by. 8.3.1 Area should be barricaded and secure for UN
authorized entry.
8.3.2 Maintain good housekeeping.
8.3.3 All material should stored and secured.

9.1 Unauthorized entry. 9.1.1 Obtain the required Work Permit in

9 TESTING & COMMISSIONING accordance with SHEM-08.10 (Work Permit) Receiver/
(Electrical) 9.1.2 Competitive and skilled person should be Supervisor L
carried out the job. / Safety officer.
9.1.3 Barricade the affected area and sign.
9.1.4 Required appropriate permission from
concern departments.
9.1.5 All tools shall be inspected and should be in
usable condition in accordance with SHEM-
08.07.

9.2 Physical injury. 9.2.1 All required basic PPE(with working gloves)
shall be used in accordance with SHEM-
08.08
9.2.2 Do not lift over load manually

10.1.1 Working area must be clean on daily basis

10 Housekeeping in order to avoid slipping tripping falling
10.1 Trip and Slip and any other situation may cause injury. Receiver/ L
10.1.2 Adequate disposal of Empty cans off Supervisor
chemical must be remove from site and / Safety officer.
place away from combustible material as
per waste disposable local authority
requirement.
10.1.3 Daily conduct good housekeeping as per
work permit procedure.
10.1.4 Skip bins are provide for the waste
handling and disposal.
11.1.1. Awareness for Covid 19 to be shared
during tool box.
11 Covid -19 infection 11.1. Risk of spreading 11.1.2. Providing workers with up-to-date
Covid 19 cause education and training on COVID-19 risk
personal infection. factors and protective behaviors (e.g.,
etiquette and care of PPE).
11.2. Covid 19 can cause 11.1.3. Encourage to worker don’t hand shake
illness and death and gathering.
11.1.4. Temperature reading must be captured
prior to Entry time daily basis.
11.1.5. Maintain of social distance should be S
Classification: Internal Use

followed.
11.1.6. Wear face mask all the time.
11.1.7. No spitting on the floor or metal surface.
11.1.8. Disposal of PPE after use must be dispose
to designated dustbins.
11.1.9. Provider of Hand sanitizer and hand wash
should be available at work site.
11.1.10. Personnel Hygiene (Hand wash with soap
before eating, using own water bottles)
11.1.11. Maintain regular housekeeping practices,
including routine cleaning and
disinfecting of surfaces, equipment,
office, rest shelter, toilets and other
elements of the work environment.
11.1.12. Encourage workers to stay home if they
are sick.
11.1.13. Employee health monitoring form should
be filled on daily basis and submitted to
concern client.
Classification: Internal Use

REQUIRED AND/OR RECOMMENDED P.P.E.: Safety Helmet, safety glass, safety harness, safety gloves, safety mask, earplug & face shield.

Prepared by: JSA Team Leader Acknowledged by: Manager/Shift supervisor.

Name: _ Signature: ID #:
Name: Signature: ID#:
JSA Team Members:
Department
Name ID # Signature Date Reviewed and acknowledged by Operation Sr. Manager In case of Major
/ Significant Risk (Critical Activity).

Name: Signature: ID#:

Comment: …………………………………………………………………………………………………
…………………………………………………………………………………………………………………..
…………………………………………………………………………………………………………………..
…………………………………………………………………………………………………………………..
…………………………………………………………………………………………………………………..

Approved by Maintenance Manager/ Supervisor.

Name: Signature: ID #:

Approved by Maintenance Sr. Manager in case of Major / Significant Risk

(Critical Activity).

Name: Signature: ID #:
Classification: Internal Use

INSTRUCTIONS FOR COMPLETING THE JOB SAFETY ANALYSIS FORM

Job Safety Analysis (JSA) is an important incident prevention tool that works by finding hazards
and eliminating or minimizing them before the job is preformed, and before they have a chance to
become accidents. Use JSA for job clarification and hazard awareness, as a guide in new
employees training, for periodic contacts and for retraining of senior employees, as a refresher on
jobs which run infrequently, as an incident investigation tool, and for informing an employees of
specific job hazards and protective measures.
Set priorities for doing JSA’s: jobs that have a history or many accidents, jobs that have produced
disabling injuries, jobs with high potential for disabling injury of death, and new jobs with no
accident history.
Select a job to be analyzed. Before filling out this from, consider the following:
The purpose of the job-What has to be done? Who has to do it?. The activities involved: How is it done?
When is it done? Where is it done?
In summary, to complete this form you should consider the purpose of the job, the activities it involves,
and the hazards its presents. If you are not familiar with a particular job or operation, interview an
employee who is. In addition, observing an employee performing the job, or “walking through” the
operation step may give additional insight into potential hazards. You may also videotape the job and
analyze it. Here’s how to do each of the three parts of Job Safety Analysis

RESPONSIBLE
SEQUENCE OF BASIC JOB STEPS POTENTIAL HAZARDS RECOMMENDED ACTION OR PROCEDURE
PERSON

Examining a specific job by breaking it down into a
series of steps of tasks, will enable you to discover
potential hazards employees may encounter.
Each job operation will consists of a set of steps or
tasks.
For example:
The job might be to move a box from conveyor in
the receiving area to a shelf in the storage area.
To determine where a steps begins or ends, look
for a change of activity, change in direction or
movement.
Picking up the box from the conveyor and placing
it on a hand truck is one step. The next step might
be to push the loaded hand truck to the storage
area (a change in activity). Moving the boxes from
the truck and placing them on the shelf is another
step. The final step might be returning the hand
truck to the receiving area.
Be sure to list all the steps needed to perform the
job. Some steps may not be performed each time;
an example could be checking the casters on the
hand truck. However, if the step is generally part
of the job it should be listed.
A hazard is a potential danger. The purpose of the Job
Safety Analysis is to identify all hazards, both those
produced by the environment or conditions and those
connected with the job procedure.
To identify hazards, ask yourself these questions about
each step:
1. Is the danger of the employee striking against, being
struck by, or otherwise making injurious contact with
an object?
2. Can the employee be caught in, by or between
objects?
3. Is there potential for slipping, tripping, or falling?
4. Could the employee suffers strains from pushing,
pulling, lifting, bending, or twisting?
5. Is the environment hazardous to safety and/or health
(toxic gas, vapor, mist, fumes, dust, heat, or
radiation)?.
Close observations and knowledge of the job is
important. Examine each step carefully to find and
identify hazards; the actions, conditions and possibilities
that could lead to an accident. Compiling an accurate
and complete list of potential hazards will allow you to
develop the recommended safe job procedures needed
to prevent accidents.
Using the first two columns as a guide, decide what Who is responsible? Write the
actions or procedures are necessary to eliminate or person (receiver) responsible
minimize the hazards that could lead to an accident, (Supervisor/Work Permit
injury, or occupational illness. Issuer/receiver/contractor) to
implement the control measures
Begin by trying: identified.
1. Engineer the hazard out: 2. provide guards, safety
devices, etc.; 3. provide personal protective equipment; 4.
provide job instruction training; 5. maintain good
housekeeping; 6. insure good ergonomics (positioning the
person in relation to the machine or other elements in
such a way as to improve safely).
List the recommended safe operating procedures. Begin
with an action word. Say exactly what needs to be done to
correct the hazard, such as, “lift using your leg muscles”.
Avoid general statements such as “be careful”.
List the required or recommended personal protective
equipment necessary to perform each step of the job.
Give a recommended action or procedure for each hazard.
Serious hazards should be corrected immediately. The JSA
should then be changed to reflect the new conditions.
Finally, review your input on all three columns for
accuracy and completeness. Determine if the
recommended actions or procedures have been put in
place. Re-evaluate the job safety analysis as necessary.